Pain specialist and Honorary Clinical Director of Integro Medical Clinics, Dr Anthony Ordman tells Sarah Sinclair why cannabis based medicines should be taken seriously as an alternative to conventional medicines – and how we can bring them into the mainstream.
“On balance, the medicines which we traditionally use to treat long-term pain, can do more harm than good,” says Dr Anthony Ordman, a senior pain specialist with more than 25 years experience in treating patients with long-term pain.
“If we’re not careful, we’re in danger of people being made worse by their pain medicines rather than better, for example they may end up over-sedated, but without any reduction in pain.”
Earlier this year, The National Institute of Health and Care Excellence (NICE) published a report on the use of medications for the treatment of long-term pain. It referred to a ‘lack of evidence’ for the long-term effectiveness of many of these medicines, and a risk of long-term harm, advising doctors not to prescribe common painkillers such as paracetamol and ibuprofen for patients with chronic pain.
Dr Anthony Ordman agrees that many conventional medicines have little to offer those living with conditions such as fibromyalgia.
“Doctors may prescribe these medicines in a well-meaning way, but only about a quarter of patients are really helped by them, whereas they all tend to experience side effects including sedation and memory deficit.
They can also tend to get hooked on them and never come off,” he adds.
“We have to find other options.”
As Honorary Clinical Director at Integro, Dr Ordman does offer patients alternative options. These take the form of cannabis based medicines, which he believes can often be more effective for treating chronic health conditions.
“We’ve been aware of the body’s natural endocannabinoid system for a long time. We believe this can become unbalanced in pain states and can often be re-balanced using cannabis based substances,” he explains.
“Medical science has known about this system for 30 years, but because of drug regulations and a concern among most doctors about the reputation of cannabis medicines, little progress was made.”
But in 2018, the regulations were changed so that medical specialists could prescribe cannabis based medicines. As far as Dr Ordman is concerned cannabis medicines can be a useful part of a whole-person approach to medicine, something which has always been at the heart of his medical practice.
Patient-centered care was a philosophy which he brought this with him to Integro, where patients are looked after by a team of clinical professionals, including a specialist nurse, in order to offer the best treatment possible.
“If patients have already tried cannabis based medicines, we listen carefully to their experience, and try to build on that,” he says.
“We try to work in partnership, rather than a paternalistic way, and there’s always somebody for patients to phone if they have a query or a problem. This is the sort of medicine I have always been keen to practice.”
Rather than just attempting to control pain, as is often the case with opioids, cannabis based medicines can be used to tackle a number of elements associated with pain which might also be affecting the patient’s quality of life, for example anxiety, poor sleep and low mood.
“Adverse life experiences, especially in childhood, can make peoples’ bodies much more prone to chronic pain later on, and what we’re often trying to do is restore balance in body systems which have become unbalanced by these experiences, or by ill-health, injury, and so on,” says Dr Ordman.
“I believe that, for example in fibromyalgia, real neurological changes have happened as a result of intense stress.”
He continues: “A lot of patients with long term pain or anxiety have impaired sleep physiology, so they wake up exhausted, and their body hasn’t had a chance to heal during the night. Cannabis medicines can help restore healthier physiological sleep patterns, which pain medicine now realises can be really important for restoring physical health and reducing pain.
“Another benefit of cannabis medicines is that they may be able to reduce inflammation in various parts of the body, and many types of pain are driven by inflammation, for example at the sites of injury and arthritis.”
One example is that some patients treated for Crohn’s Disease, an inflammatory condition of the digestive system, who are prescribed cannabis medicines to help manage their pain, may notice a reduction in the frequency of their flare ups as well.
Although Integro Clinics keep their charges to a minimum and have reliable access, via their partner pharmacy to high quality cannabis medicines currently it is mainly those able to afford to purchase their cannabis medicines who are able to access these treatments.
While Dr Ordman acknowledges that some forward-thinking consultants are taking an interest in using medical cannabis, helping more clinicians to understand cannabis medicines is key to seeing wider access through the NHS, he feels.
“The way forward in bringing cannabis based medicines more into mainstream medicine is through the understanding from a doctor’s point of view, that the chemicals in cannabis should just be regarded as molecules, like any other medicine.”
“Just as morphine came originally from poppies, and the heart medicine digoxin came from foxgloves we’re dealing here with chemicals which just happen to come from a cannabis plant. And like morphine or digoxin, these also work on systems that have been present in animals for millions of years.”
He adds: “Patients may tend to view cannabis medicines in a romantic way, because they’re from a cannabis plant, but doctors are more likely to see them in a more matter of fact way, as chemical extracts from cannabis which we can measure and analyse, in proper controlled ways.”
But patients do have an important part to play, as they are often the most knowledgeable and best-placed to broach the subject of medical cannabis with their doctors. Often they will have tried medical cannabis for their long-term condition and have a good idea of what best suits their condition.
“I think the way into the NHS and broader acceptance may be through expert patient groups and providing scientific and other information that patients can take to their appointments. This could inform their consultants or GP’s and put them in touch with their cannabis medicine doctor in a way that doesn’t seem to be confrontational.”
Dr Ordman is currently inviting a few select NHS colleagues to join him at Integro Clinics, where they would be supported in learning about prescribing cannabis-based medicines for a range of conditions and to carry out much-needed clinical trials.
“We’d love to have a gastroenterologist, a rheumatologist, a psychiatrist, as well as an adult and pediatric neurologist as colleagues at Integro Clinics”, he adds.
“Making lead consultants in the NHS aware of how cannabis medicines can be valuable for patients with hard-to-treat conditions such as intractable pain or epilepsy is important, and there may be other conditions for which cannabis medicines have more to offer, perhaps in conjunction with conventional medicines.”
Find out more and get in touch with Dr Ordman’s team at www.integroclinics.com <http://www.integroclinics.com/>
Integro Clinics Ltd always recommend remaining under the care and treatment of your GP and specialist for your condition while using cannabis based medicines, and the Integro clinical team would always prefer to work in collaboration with them.
Fibromyalgia and cannabis: What does the latest research say?
Cannabis Health rounds up the latest research into the impact of cannabis on fibromyalgia.
There are thought to be around 1.5-2 million people in the UK currently living with fibromyalgia, a condition which causes chronic pain around the body, muscle stiffness and fatigue.
With no cure for the illness and symptoms severely affecting day-to-day life, research is focusing on therapeutic treatments – including medical cannabis.
In 2019, research published by Sagy, Schleider, Abu-Shackra and Novak showed that cannabis can help reduce fibromyalgia pain. The study of 367 patients found that pain intensity decreased when treated with medical marijuana, leading the team to state that “cannabis therapy should be considered to ease the symptom burden among those fibromyalgia patients who are not responding to standard care”.
Chaves, Bittencourt and Pelegrini further supported these findings in October 2020, concluding that phytocannabinoids can serve as an affordable yet well-tolerated therapy for fibromyalgia symptom relief and quality of life improvements.
After the randomised controlled trial, the researchers went as far as to suggest that the cannabinoid therapy “could become an herbal or holistic choice of medicine for treating fibromyalgia as part of Brazil’s public healthcare system”.
A study in Italy, published in February 2020, also demonstrated that medical cannabis improves the efficacy of standard analgesic fibromyalgia treatments.
Researchers concluded: “This observational study shows that medical cannabis treatment offers a possible clinical advantage in fibromyalgia patients, especially in those with sleep dysfunctions.”
Published in the Clinical and Experimental Rheumatology journal, the study followed 102 fibromyalgia patients who had not responded well to conventional treatments. These participants were given two forms of medical cannabis oil extracts and researchers then collected data over a six-month period from patients, who self-reported fibromyalgia symptoms, how well they slept, and feelings of fatigue, as well as depression and anxiety levels.
While only a third of fibromyalgia patients reported reduced symptoms of the disease overall, cannabis did improve overall quality of life for some. Fewer symptoms of depression and anxiety were found in around half of patients, too.
Despite fibromyalgia being more common amongst women – up to 90 per cent of sufferers are female – one study has found that cannabis may provide better pain relief for men.
The preclinical studies, conducted in 2016, compared the analgesic, subjective and physiological effects of active cannabis and inactive cannabis in male and female cannabis smokers under double-blind, placebo-controlled conditions, and measured pain response through the Cold-Pressor Test.
Among men, active cannabis significantly decreased pain sensitivity relative to inactive cannabis. However, in women, active cannabis failed to decrease pain sensitivity relative to inactive, indicating that in cannabis smokers, men exhibit greater analgesia compared to women.
Researchers concluded: “Sex-dependent differences in cannabis’ analgesic effects are an important consideration that warrants further investigation when considering the potential therapeutic effects of cannabinoids for pain relief.”
While further research is necessary, it is clear to see that medical cannabis can make a huge difference to treatment and relief of pain caused by fibromyalgia.
The best ways to take CBD for pain relief
CBD is becoming a popular tool for pain management, but with so many options out there, how do you know where to start?
With research constantly emerging to support the health benefits of CBD, more and more people are turning to the remedy – especially when it comes to alleviating pain and discomfort.
But how does it actually work? There are several ways to take CBD, each offering various pros and cons – we’ve rounded up some of the best methods.
In terms of pain relief, one of the most common methods is on the skin. Topical products like lotions and balms can be applied to skin over painful joints or bones and are particularly effective when used to relieve symptoms of arthritis.
However, research is still ongoing to determine whether these products deliver CBD below the skin. It is also difficult to pinpoint the exact effect CBD delivers – with many including common over-the-counter ingredients such as menthol, capsaicin and camphor, it’s uncertain whether the positive relief is solely due to CBD, or if these other ingredients play a significant role.
Several studies have hailed CBD oil as one of the most helpful methods when it comes to relieving pain symptoms, especially when combined with other forms such as topicals.
Medical nutritionist and health author Dr Sarah Brewer said: “Cannabidiol oil has direct effects on the endocannabinoid system in the brain. This enhances the effects of other brain chemicals, such as serotonin and anandamide, to reduce pain perception. It is also a powerful antioxidant which suppresses inflammation.”
Something to digest
Another well-known method for using CBD is by mouth. Whether in capsules, food or liquid, CBD that is swallowed is absorbed through the digestive tract.
Despite its popularity, this method does have its downfalls. Absorption is slow and dosing can be tricky due to the delayed onset of effect (it can take one to two hours to fully have an impact), plus many believe there isn’t enough research into how recent meals and other factors affect consumption.
But it has been widely reported that after a safe and effective dose has been established, capsules can work for daily use.
While it may not taste particularly pleasant, CBD can also be effectively absorbed directly into the bloodstream by holding liquid from a spray or dropper under the tongue. Research shows effects can the be felt in as little as a few minutes.
Give the vapors
CBD can also be inhaled via a vaporising, ‘vape’ pen. However, it’s possible that inhalation can carry unknown risks, particularly in those with respiratory issues and ailments such as inflammatory arthritis, and so isn’t widely recommended as a method for use.
With all methods, the common downfall is wavering dosage guidelines. Measures can change depending on a number of factors including age, weight and reason for use, however resounding guidance from experts is to ‘go low and slow’. Start with just a few milligrams twice a day, and if relief is inadequate after one week, increase the dose by the same amount, in small increments over several weeks if needed.
It’s clear that more research is needed to determine exact details into these methods, but this is only set to increase as the number of people turning to CBD for pain relief continues to grow.
CBD distillates, isolates & full spectrum – what’s the difference?
With so many CBD products on the market, do you know your distillates from your isolates? The experts at US manufacturer Fresh Bros break it down.
Las Vegas manufacturer Fresh Bros have nearly a decade of experience in the hemp industry.
But with so many products on the market Fresh Bros want to help consumers find the best products for their needs.
Here they explain the differences between CBD distillate, CBD isolate, and full-spectrum CBD products, as well as highlighting the key differences between Delta 8 THC and Delta 9 THC.
Cannabidiol (CBD) is one of the most researched compounds of all the known phytocannabinoids found in the cannabis plant.
CBD isolates are, unsurprisingly, isolated forms of CBD. During the extraction process, cannabidiols are removed or filtered out of the hemp plant except for CBD, resulting in a pure product.
CBD isolate is great for anyone who struggles with the original earthy flavors of other conventional oils or edibles, so if you’d prefer a high-potency CBD product that is tasty, doesn’t contain THC and or any “extra” cannabinoids that are found in a distillate or full-spectrum product — CBD isolate may be the way to go.
Unlike CBD isolate, CBD distillate (aka broad-spectrum CBD) typically contains an array of cannabinoids, terpenes, vitamins, and fatty acids that are very beneficial to the body. CBD distillate contains only negligible amounts of THC after going through special processing.
CBD isolate is an incredible healing source, of course, but there are hundreds of other beneficial cannabinoids found in the hemp plant besides CBD – cannabinol (CBN) and cannabigerol (CBG) to name a couple.
Therefore, if you want to reap all of the potential benefits of CBD without the high, and you don’t mind the stronger taste, CBD distillate may be the best option for you.
Full-spectrum CBD products contain all cannabinoids, terpenes, and plant materials – including the naturally occurring small amount of THC in hemp.
Delta 8 THC vs Delta 9 THC
The cannabis plant has more than 120 cannabinoids, but only a fraction of these have really been studied and marketed. Delta 9 THC is the psychoactive compound found in cannabis, and has received a lot of attention over the last few years.
However, consumers are slowly noticing the lesser-known Delta 8 THC (a less available double-bond isomer of the more common Delta 9 THC, also derived from hemp) due to its unique properties. The main differences between these two types of THC are found in the molecular structures of both, and it’s worth noting that Delta 8 THC is capable of producing a milder, more manageable, and more enjoyable high compared to Delta 9.
Delta 8 also has added therapeutic benefits and less severe and functionality-impairing side effects.
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